Mental health centers around Kansas are leading some of the most expensive KanCare recipients through the health care system under a new agreement with the three managed care organizations.

The mental health centers are creating “health homes” to serve people with severe mental illnesses or other chronic conditions who are covered by KanCare, the Kansas version of Medicaid run by three companies.

Serious mental illnesses, as defined by the health homes program, include schizophrenia, bipolar disorder, major depression, psychosis, obsessive-compulsive disorder, post-traumatic stress disorder, delusional disorders and personality disorders, according to a document provided to Valeo Behavioral Health Care. People who don’t have a mental illness are still included if they have asthma or diabetes and are at risk of developing other conditions.

Tami Wichman, health home nurse coordinator for Valeo, which provides mental health services to Shawnee County residents, said the health homes don’t replace primary care. Instead, they try to coordinate care for vulnerable people, with the goal of reducing hospitalizations and improving their health, she said.

The team will include people who teach clients about healthy living, refer them for support services like transportation and help schedule follow-up care after a client is discharged from the hospital or emergency room, Wichman said.

Valeo estimates between 800 and 1,500 people who meet the criteria could be assigned to them by the three managed care organizations, though they didn’t have a definitive count when the service officially began Friday, Wichman said. She said they could need 20 to 40 employees to help the recipients to navigate the system and develop health goals.

“There’s a lot of unknowns,” she said.

Karen Smothers, clinical director of Pawnee Mental Health Services, said as of the start of this week they still hadn’t been told the number of clients assigned to them. They will work with people in 10 counties, and are still hiring care coordinators, but can’t decide how many to hire until they know how many clients are assigned to them and if any will opt out, she said.

“We’re guesstimating between 500 and 700 enrollees,” she said.

They are planning to send out information about the health home concept to eligible clients and to invite them for a health assessment, Smothers said. Those who accept will work with the health home employees to develop a plan with concrete steps, such as finding a primary care doctor, learning how to buy and cook healthy foods and quitting smoking, she said.

The health home also will help clients find resources like transportation to appointments if they need it, Smothers said, and they may be able to offer some sort of incentives for adopting healthier behaviors.

People with severe mental illnesses live about 10 years less on average than the general population, Smothers said. Lack of social support and access to health care account for some of that discrepancy, as do side effects such as weight gain and high blood sugar that can result from medications taken to control symptoms of mental illness.

People with severe mental illnesses also may not understand their physical conditions, may mistake physical symptoms for something caused their mental health condition or may move too frequently to establish a relationship with a health care provider who could spot problems, Smothers said.

“There’s a lot of variables,” she said.

Pawnee’s mental health clinics already ask whether clients have a primary care doctor and whether they have had a recent check-up, and do referrals for follow-up if a person’s symptoms seem like they might come from a cause other than mental illness, Smothers said.

“I believe the health homes are going to formalize that,” she said.

Bill Persinger, executive director of the Mental Health Center of East Central Kansas, said they also had tried to integrate mental and physical health through working with Flint Hills Community Health Center before the health homes concept was introduced in Kansas. The health center serves Wabaunsee, Osage, Coffey, Lyon, Morris, Chase and Greenwood counties.

“You can’t just take a human being and treat the mental or the physical,” he said.

Part of their work involves helping the person to come up with health goals, Persinger said. They also pass along information to clients about how to improve their health and encourage them to seek medical attention before problems get out of control, he said.

“We all know that a healthier population is a less expensive population and a more productive population,” he said.

Valeo had previously opened a primary care clinic for mental health patients to get treatment and education about other health concerns. Laura Sidlinger, a nurse practitioner, said they recorded 550 visits in the first nine months of offering the clinic, and decided to add a second room and expand hours from 12 per week to 30.

“That’s a lot of consumers served in a very short amount of time,” she said. “The patients are very appreciative.”

Some people they work with didn’t trust other doctors or had trouble finding someone who understood their mental illness, Sidlinger said. Others needed more one-on-one time than most doctors normally could give, she said.

Sometimes, just educating a person about their care can make a difference, Sidlinger said. One patient had severe stomach pain and told her that he had completed treatment, but tests suggested he hadn’t. She explained why he needed to follow the directions specifically for the treatment to work, and he completed it successfully.

“Now he’s not in constant pain. He can focus on other things,” she said.

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This is a very significant and innovative program for this population and will garner positive results as well as preventive care that will provide meaningful reductions in healthcare costs. Most importantly, those afflicted with mental health issues will be given a valuable support service and one that will actually be beneficial for their specific needs. Just a great initiative!

could be great. However, you're dealing with 3 different private companies that have no clue as to what they're doing or what providers should be doing. They are all setting up different billing systems and paying different rates to service providers. One in particular says you bill at state rate and we'll pay you 85% of that. So off the top Brownies private pay people rake off a 15% profit. Isn't that a great return for "private" companies?

Would you please explain what you are talking about? There are no per patient billings associated with the health home program administered via KanCare which is the subject of this article and the only topic being addressed. KanCare is absolutely not destroying the Medicaid system in Kansas. Exactly how much knowledge and experience do you have in the healthcare delivery system, including, of course, the health insurance arena?